Gradual and nonspecific
onset of fever, malase, fatigue, nonproductive cough and mild chest
discomfort.
- Initial symptoms are followed
by a short perod of improvement (hours to 2-3 days)
- Abrupt onset of severe
repiratory distress with dyspnea, diaphoresis, stridor and
cyanosis.
- Septicemia, shock and death
usually follow within 24-36 hours after onset of respiratory distress.
Gastrointestinal: In the
Intestines
- Presents with severe sore
throat or a local oral or tonsillar ulcer.
- Nonspecific symptoms of
nausea, vomiting and fever.
- Followed by severe abdominal
pain with hematemesis and diarrhea
Treatment for Anthrax:
- Ciprofloxacin 400mg IV every
8-12 hours or 500mg by mouth twice daily for four weeks.
- Employ standard precautions
for handling, treating, and moving all active cases.
Prevention -
prophylactic vaccination series
Plague - caused by the
bacterium Yersinia pestis which naturally infects rodents in certain
parts of the world. There are three main types of plague: Bubonic, Pneumonic
and Septicemic.
Causes of Plague
- The primary mode of
transmission is flea bites.
- A secondary source of
infection is through aerosolized droplets of sputum from an infected person.
Signs and Symptoms of Plague
Bubonic
- Acute onset fever, malaise,
headache nasea/vomiting
- Swollen lymph nodes in the
groin or axilla region
- May have lesion at flea bite
site
- Bubonic plague may progress
spontaneously to the septicemic form with organisms spreading to the lungs and
producing pneumonic disease.
Pneumonic
Acute onset fever, chills and
malaise
Hemoptysis
Nausea/vomiting/diarrhea and
abdominal pain
Dyspnea, stridor and cyanosis
Death is caused by respiratory
failure and circulatory collapse
Almost always fatal if not treated within 24 hours
Septicemic Plague
- Fever, chills, malaise,
nausea, vomiting and diarrhea
- Purpura (a rash from destroyed
blood cells leaking into the skin)
- Acral cyanosis (discoloration
of the extremities)
- Abdominal pain
-
25% of bubonic plaques progress septicemic plague
Treatment for Plague
- Quarantine the casualty for
the first 48 hours
- Maintain standard precautions
for bubonic plague patients and droplet precautions for pneumonic plague
patients
- Streptomycin 30mg / kg / day
IM in two divided doses for 10 -14 days
- Doxycycline 200mg IV then
100mg IV BID, until clinically improved then 100mg PO BID for a total of 10-14
days
-
Vigorous fluid resuscitation
Prevention
-
prophylactic vaccination series
Viral Agents
Smallpox
-
a systemic viral disease caused by the variola virus. Endemic smallpox
was declared globally eradicated in 1980 by the World Health Organization
(WHO). The only WHO-approved repositories of the variola virus are in the
Centers for Disease Control and Prevention (CDC) in Atlanta, GA and in the CDC’s
counterpart, Vector, in Koltsovo, Russia.
Causes of Smallpox
- Contact with infected
respiratory discharge
- Contact with infectious bed
linens or clothing of casualties
-
Contact with drainage from wound
Signs and Symptoms of Smallpox
- Sudden onset of nonspecific
symptoms:
Fever
Headache
Backache that lasts 2-3 days
Vomiting
Malaise
- Two to three days after
initial onset, a rash appears. It starts with face, hands and forearms, moves
to the lower extremities and then to the trunk. Lesions will appear as minute
macules, then papules, vesicles, pustules and finally scabs. Scabs form at 8 -
14 days and slough off at 14 - 28.
- Casualty is infectious
throughout the entire term of the disease until the scab separates and falls
off.
- All lesions occur
simultaneously
Treatment for Smallpox
Quarantine the casualty and
maintain strict sterile procedures.
Supportive care
Prevention of Smallpox
- Prophylaxis:
Vaccination of vaccinia virus. Revaccination should be carried out every 10
years for personnel who are at risk of infection.
- There are no routine
immunizations of US forces for smallpox. When the threat indicates, senior
leadership may direct vaccination of personnel.
Biological Toxins
Botulism -
a
biological toxin caused by the bacterium Clostridium botulinum. It is the
most toxic substance to man. Due to its incredible potency and relative ease of
manufacture, botulism toxin is considered a likely threat. Botulism acts as a
neurotoxin.
Causes of Botulism
Inhalation
Ingestion
Signs and Symptoms of Botulism
Blurred vision
Dry mouth
Dysphagia (difficulty
swallowing)
Diplopia (seeing double)
Muscular weakness
Symmetrical flaccid paralysis
(Loss of tone and reflexes)
Respiratory arrest
Treatment for Botulism
Rest
Oxygen, if available
Cricothyroidotomy, if needed
Mechanical ventilation
IV and IM administration of
trivalent botulinum antitoxin (ABE)
Ricin
-
a toxin made from the mash that is left over after processing Castor beans for
oil. Castor bean processing is a worldwide activity; therefore, the raw
materials for making ricin are readily available. The toxin may be either
inhaled or ingested. Ricin acts directly on cells by inhibiting protein
synthesis, which causes cellular death and tissue necrosis.
Signs and Symptoms of Ricin
Inhalation
Acute onset of fever
Respiratory Distress
Hypoxia
Cough
Malaise (discomfort, weakness,
fatigue)
Myalgia (tenderness in the
muscles)
Pulmonary edema within 18-24
hours
Death occurs within 36 to 72
hours
Ingestion
Severe vomiting
Abdominal cramping
Diarrhea
Shock
Renal failure
Circulatory collapse
Treatment for Ricin
An antitoxin is NOT
available.
Give supportive care
Isolation is not required
4.
FOUR PHASES OF DEFENSE OR PROTECTIVE MEASURES AGAINST BW AGENTS
Pre-attack Phase of Biological Warfare
Train and inform personnel of
possible agents.
Discourage rumors.
Practice good sanitation and
hygiene.
Ensure immunizations are up to
date.
Protect
supplies and equipment.
Attack Phase of Biological Warfare
Signs
of attack include
Aircraft spraying or
dropping objects.
Lobbing of low
blast shells or bombs
Smoke or mist of
unknown origin
Dead animals with
no visible cause
Rapid increase of
patients at sick call
Defensive measures include:
Stop breathing and
don protective mask.
Give the alarm.
Remain under cover,
and move outside only after cloud has passed or "ALL CLEAR" is sounded.
Cover exposed skin.
Post-Attack Phase of Biological Warfare
CONTINUE to practice an
increased level of good health, field sanitation and hygiene discipline.
Keep
wounds, cuts, and scratches clean by using soap, water and utilize available
first aid. Don't consume local foods.
Eat and drink only approved
food and water.
Do not bathe in lakes, ponds
and streams.
Do not touch animals,
especially dead ones.
Observe BW contamination markers.
Decontamination
Phase
Designate an area for the
decontamination station.
Establish and operate the
station.
Provide personnel for monitoring
teams.
Post NATO Biological Warning
Markers. A triangular
shaped marker measuring 11" x 8" x 8" with blue background and red letters
spelling "BIO". (See figure 1.)
Figure
1. NATO Biological Warning Marker
REFERENCE
Medical Management of Biological Casualties, July 2000
REV: July 2008
Biological Agents Review
1.
List the signs and symptoms of inhalation anthrax.
2.
When and where does the small pox rash develop?
3.
Identify three facts about Botulism.
4. List three actions to avoid during the “Post-Attack” phase of biological
warfare.
